Provider Demographics
NPI:1942428529
Name:CHONG, YOUNG CHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:CHA
Last Name:CHONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3311
Mailing Address - Country:US
Mailing Address - Phone:215-635-0570
Mailing Address - Fax:215-635-1149
Practice Address - Street 1:335 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3311
Practice Address - Country:US
Practice Address - Phone:215-635-0570
Practice Address - Fax:215-635-1149
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023641L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice